Impact of Medicare prospective payment system on acute rehabilitation outcomes of patients with spinal cord injury

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Study examined the impact of Medicare’s inpatient rehabilitation facility (IRF) prospective payment system (PPS) on inpatient rehabilitation outcomes for patients with traumatic spinal cord injury (SCI). A sample of 296 Medicare and 3,110 non-Medicare patients was selected from the National SCI Statistical Center Database from 1996 to 2006. The main outcomes of interest were Functional Independence Measure (FIM) Motor score change and length of stay (LOS). Analysis revealed that LOS decreased by about 5.8 days a year for Medicare patients and about 1.3 days a year for non-Medicare patients after PPS implementation. Although significant decreases in LOS were observed for Medicare patients after IRF PPS implementation, Medicare patients’ improvements in motor function did not decrease. Non-Medicare patients with SCI also experienced shortened stays after Medicare IRF PPS implementation, but had equivalent FIM score gains compared with their counterparts who received inpatient rehabilitation care before PPS implementation. In summary, IRF PPS implementation was associated with shorter stays, but was not associated with lower functional improvement.

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